'tis the season

I know, I know.  I should know better. 

The grocery store two days before (insert holiday here).   I am not hosting Thanksgiving this year, so I didn't need much beyond bread and milk....and coffee creamer...and lettuce.  

I try not to be in a hurry.  Hey, I'm retired.  When it's busy, whats the point? Many are trying to race around, I know it's useless and wastes energy and pisses people off.   I wait patiently for the folks who are taking too long right in front of the canned goods I want, say excuse me (pleasantly) to the individual having a cell phone conversation in front of the bananas, assist the elder woman who can't find the bread she needs.  The hard working employees are busy trying to restock shelves, and doing a great job amid chaos.  

I'm doing just fine as I make my way around the store, enjoying not having to BE anywhere or DO anything pressing.... until I got to the end of the cereal aisle.   I slowly and carefully maneuver around the employee stocking shelves at the very end of the row with an "excuse me" and a smile.  Just then, coming around the corner into the aisle like there's a blue light special is a Karen on a mission.  As I am nearly past the employee, Karen impatiently waits for me to clear the stocker.  She mutters a sarcastic "you're welcome" under her breath as she races down the aisle with a cart laden with carbohydrates.  I responded with a slightly more audible but pleasant "fuck you".  It is the holiday season, after all.

Snort of suppressed glee from the employee.

Springing into health

I wrote the following before two things happened: 

 1. Covid, fortunately mild but with a cough and exercise intolerance that lasted weeks

 2.  Renting a house down south for the month of February, a new experience for this North of the Arctic Circle girl.  It was winter when we arrived, now it's a little spring-like, and nice at the beach.  For an hour or two.  With a sweatshirt and pants.  These southern people embrace it though, so there's that.  

In my retirement I have enjoyed belonging again to  an athletic club and have been doing lap swimming regularly, the only exercise that doesn't tax my knee.  I've also attended some water aerobic type classes but there is only one instructor that really seems to want you to have a good workout.  It's filled with old ladies who love to chat with each other.  I get that it's social, but I really just think it's rude to have conversations when the instructor is pouring her heart into a class and others are trying to get something out of it besides a social interaction and not getting your hair wet.  Change my mind. I'll fight you. I still have a lot of unresolved anger, but I'm working on that, I promise.

The good thing about my facility is that I have to reserve a lap lane in advance, which motivates me and creates some accountability.  I'm partial to lane 4 (of 5), in late morning, when the sun is nice and the staff have cut the overhead lights.  Because laps are boring, and I'm swimming about 50-55 minutes (up to 64 laps in a 25 meter pool, yay me), I purchased an inexpensive waterproof MP3 player with earbuds that also keep out water out of my ears.   After 15 or 18 laps, it gets easier.  I can block out the neighboring lap swimmers, enjoying a kind of sensory zen.  

Well.  Most of the time.

There is one swimmer I really hate to swim next to.  She is quite a bit younger, very fit and focused.

I call her the Water Buffalo, Water Buff for short.  

I don't know if it is a training method, but she literally SLAPS the water with each stoke,  She is trying to punish it.  She is an angry elf.  "I hate you water.  I will kill you"

As if this violence isn't distracting enough, sometimes she puts on a pair of slappy plastic hand paddle thingies, or some slappy plastic fins on her feet.  The worst is when she does this awkward kind of angry hybrid breast/butterfly stroke.  It doesn't move very far.  It is fairly intense.  All of her techniques have in common they are loud and create a lot of splash.

I mostly try to ignore her, but Water Buf displaces a lot of water splashy-splash in my direction, which I find VERY distracting.

Me, I like to try to slide through the water as easily and hydrodynamically as possible, concentrating on the elements of my swimming: breathing, rotation, stroke, pull, kick; a different focus every few laps.  I'm not strict or structured as I lack formal swim training.  I've just always enjoyed it, and music makes it enjoyable.  My playlist is only a few albums of favorites.  Mostly f rom the 1970's, don't judge.  If you've never exercised to Crosby, Stills, Nash and Young or James Taylor, I can't even talk to you.

I think I will offer Water Buff the use of my MP3 player.  She seems like she could use a few laps of "So Far".  

.  

Still dirty

 Sometimes the past kind of hits you in the face, even if you are wearing a mask.  At a routine Dr. visit,  I encountered just such a blast from the past.  As we were talking about what I was retired from, the nurse disclosed that she was also a former ER nurse, albeit management (*cough*bullshit*cough)  turned infection control.  As we played the six degrees of separation game, it occurred to me that it was this very nurse

Then I laughed for a half hour.

My children of 911...20 years gone by

This post was originally published on the 10th anniversary of that awful day.  

10 years ago I was working as a school nurse for the sixth graders' annual 5 day Nature Camp trip.  This was always a fun experience for all, and highly anticipated by those of us fortunate enough to go.  The week was carnival time for faculty, a "Get Out of Jail Free" pass, Wonka Golden Ticket.  It was five days of  not sitting in a classroom.  The kids were our responsibility for three meals and overnight, but otherwise they were herded like sheep from activity to activity and supervised by the camp staff for purposes of learning and soaking up the nature.  Compared to school, it was a free for all.  There was plenty I could have done instead of going, always the first couple of weeks of school were busy.  Lots of consultations with parents and doctors, meetings with teachers, health plans for some of the more fragile kids.  I had already spent two weeks prior to the first day of school preparing for the trip as well as for the kids in my school with health needs.

These 6th graders had just moved on to the middle school, but I knew them well.  They had been my responsibility for grades 3-5, with their health problems, adjustment issues and daily boo-boos. Although there was a camp nurse (a clueless new grad) who would be distributing meds, my presence was pretty much redundant.  It was my guarantee of being there that sealed the deal for parents that their kids would be safe and well cared for.  Oh, I  checked peak flows and did asthma checks so as not to be awakened for nebs in the middle of the night for wheezy kids.  I located the kids who forgot to show up for meds.  I could tell by a look who needed special attention or a pep talk.  I managed the diabetics exclusively.  On occasion I made a trip to the ER for a few stitches (those kids always got treated to a burger or ice cream on the way back to camp but were sworn to secrecy).   I always had a few kids who had never left home for as much as a sleepover, kids who were on the verge of illness, or kids who were allergic to everything including clouds, dirt and air.  Every year there was one or two new kids who had moved to town and didn't have a single friend,  and inevitably arrived with some sort of medical issue.  I gave the really nervous parents my cell phone number since we usually left for the trip only 3 days into the school year and the mostly middle school faculty were new to the kids.  Up until that year, no one had ever called me although I did make a few calls home so they wouldn't worry too much.  Since the kids were forbidden to use the phone, it was always appreciated.

My own kids were nearly grown; my daughter was 21 and had already started her 3rd year of college the week before.  My son was starting his first year at a Boston area college the day after I returned.  It was going to be a busy week and weekend, but it was all under control.


On that day, September 11, 2001, the kids were settling into their second day of after-breakfast activities with their camp leaders.  The other 9 teachers and I had a precious 2 hours and 15 minutes until we were needed to chaperone free play time, and then lunch for the kids.  We were enjoying the beautiful sunny day on the deck overlooking a sparkling blue lake.  It was summer still, but with that unmistakable crispness that meant fall would not be far behind.  I remember how we admired the color of the sky and the green of the surrounding mountains, dotted with just a touch of red and yellow of early-changing leaves and how pretty it was as the view was reflected in the lake.  Some teachers were milling around, reading the paper on the deck and enjoying a peaceful cup of coffee or just sitting and chatting.  Two of my good friends were 5th grade teachers.  We were making a plan to escape to Dunkin' Donuts for some adult time and maybe taking out a few sailboats later in the afternoon when the kids were with their learning groups.  Joe, a grade 4 teacher drove up in his car.

"Hey", said Joe, "Something really bad happened in New York at the World Trade Center.  A plane crash.    I'm going down to the rec room TV to check on it".

We quickly followed, collecting most of the other faculty en route.  I remembered that there had been a bomb attack maybe ten years earlier.  I thought about the logistics of evacuating those buildings and what a nightmare it must have been.  In my wildest dreams I could not have imagined the horror that was to come.

We sat riveted and in shock as the events of the day unfolded.  It was like a bad dream; many of the teachers had tears streaming down their faces.  One teacher was married to a National Guardsman, another to a federal agent.  Both wondered not if but when and where their husbands would be called to duty.

At some point, it occurred to us: "What do we tell the kids?".

I suggested that we tell them nothing.  There were 10 of us, how could we handle the emotional needs of 180 kids who might have a grandfather who works in one of the towers, or whose aunt lives in New York, or  cousin working for an airline or the fire department?

Joe agreed.  He suggested that we talk to the school principal; after all, it should ultimately be their decision.  We anticipated being called home right away.  Parents would be calling the school and the camp.  We had to be prepared for an onslaught of parents driving the two hours to scoop up their kids and bring them home, and who could blame them?  

Cathy was a 5th grade teacher who worried about the safety of us all.  With planes targeting the Pentagon and White House as well as the Twin Towers, who knew what could be next?  Was it safe to even be on the roads?  What about our families?

Two 6th grade teachers, Sally and Carl were the undisputed team leaders.  They thought the best plan was to keep things as normal as possible until we heard otherwise.   As a group we agreed, then scattered to meet up with our kids before lunch for 45 minutes of free time.

Joe went to find the camp director; Sally tried to contact the school principal and/or the superintendent's office.  Overloaded telephone systems and a serious lack of cell phone service prevented her from reaching anyone.  For the next several hours, in fact for the next three days, we were cut off from the world and on our own.  

During the lunch break, camp staff were taken off and briefed by their director who ordered them to keep things as normal as possible for our kids.  Some were unhappy about that, but we were insistent. They would stick to the program. 

It was late afternoon before Sally was able to speak to anyone from school administration.  They agreed with our course of action.  After a hasty meeting with parent organizers the consensus was that as long as we, the  faculty, were OK with staying, the kids would remain at camp.   The only deviation in play was that we would leave after breakfast on Friday and arrive home before 1 PM instead of 5 PM.  Teachers on all three buses would brief the kids on the way home.  

 So, as our country grieved for the lives lost, the threat to our freedom, and the near-destruction of our piece of mind, our kids learned and played.  They bonded with teachers and classmates as a group, communed with nature, and made memories.  They missed home a little, and school not so much.  They had the freedom to eat peanut butter and jelly instead of veggie burgers, and some enjoyed their sloth, showering and wearing clean clothes only when compelled to do so.  For three more days our students did  all the normal things they had a right to do as kids.  They did not have any access to TV's or newspapers; our only link with the outside world was a few moments of news casts several times per day and newspapers, which we kept hidden.  The kids were isolated, not having access to either.  We, their teachers, protected their innocence for just a few more days, shielded them from fear and from the rest of the world.

That Friday as I drove home, I felt as though I had landed in another world.   American flags were flying from homes, schools, fire stations, police stations, public buildings.  Hand made signs and banners proclaimed that we as Americans were still strong, that nothing would break us.  There were pleas for vengeance and retribution. There were prayers for peace and for the families of the victims.  

I remember crying as I hugged my family.

For Baby Boomers like me, the assassination of President Kennedy was a tragedy that changed a generation.  For this generation, it is September 11, 2001.

But for our kids, our 180 students, our group of 11 year olds who had left home on a Monday and returned to a changed world on Friday, their experience was significantly different.  In their before-and-after-world of 9/11, there was a big pause filled with childish things, a right of passage unmarred by those attacks in our own backyard.  The world stood still for most of us, but for these sixth graders life was as it should be.

I've often wondered how their  experience at Nature Camp may have shaped their future; perhaps in a completely different way from most kids their age as they played and learned with their classmates in isolation from the sadness of the rest of the country. 

I cherish a note written by one of the parents to the 10 of us who were with their children during one of the darkest moments in history to thank us for what we had done to shield them from the horrors of reality:

"Our kids did not watch TV; they did not see the horrible images or the constant replay of planes striking the Twin Towers.  Thanks to you, our kids got to experience normalcy and innocence in a way that none of the other kids at school did, perhaps not anywhere in the country.   We are so fortunate to have such dedicated individuals who put the needs of our children first when there was so much uncertainty in the world.  Surely you feared for your own families, but never showed it to our kids.  Thanks to you, we had 180 of the happiest kids in America".

My life in uniforms

Now that I am no longer required to don any type of conformist herd clothing, I have been reflecting on the uniforms I have worn over the years.    What is it about uniforms that I loved as a kid, and hated as an adult?  I suspect it is because the hype never lived up to the reality, so uniforms were vastly disappointing.  

I attended public school, so no uniform.  In my church, only the parochial school kids were allowed to sing in the church choir, no lovely angelic white robes for me.  No altar girls back then either, sort of when I cut ties with religion on the basis of patriarchal exclusion.  I was always jealous of my brothers who got to wear full-on Little League baseball and Pop-Warner football uniforms.  I didn't count my two months of Pop Warner football cheerleading at age 10, as the required attire was black stirrup stretch pants, generic white Keds,  and a white crew neck sweatshirt, available an any discount store.  My tryout consisted of me asking the coach if I could join.  Aced it.  

My first big opportunity to join something that required a uniform was Girl Scouts.  My 1960's Brownie uniform was exactly as pictured, except for the ankle socks.  I was a knee socks kind of girl.  I'm sure my parents could ill-afford it, but I was allowed to have the whole kit and caboodle.  I happily wore it every Wednesday to school, even on picture day  along with the rest of my troop, consisting of all the little girls from both 2nd grade classes in my elementary school.  Little brown felt beanie with the Brownie logo, how I loved thee.  After third grade I went on to Junior Girl Scouts.  Hated the tie, but there was somethingu about that sash with all the badges I accumulated.  For some reason our troop split in half in 6th grade, can't remember why, but I assume it had to do with adult in-fighting.  After that, it was Junior High, and most of us dropped out at that point.  I was a leader for my daughter's troop for a few years, but by that time neither leaders nor kids wore uniforms. 

There were no organized sports teams for girls in my home town.  Other than gym class, there were relatively few opportunities for girls to do sports at all until high school.  My elementary school gym teacher was 100 years old and likely invented field hockey.  She had been the high school coach in the 1950's, so naturally we were introduced to the sport in 2nd grade.  No wonder I hated it.  We used pinnies for that, also for basketball, the only two team sports we girls had.  Think of a sort old fashioned apron just like great-grandma used to wear.   It was fun in elementary school, but by the time we hit junior high we were over them since they were never washed and smelled bad. 

Junior high school gym suits were a horrible uniform experience, as was junior high in general.  Gym suits were largely viewed as a punishment, and I never understood why they were required.   Color coded by class, they were one piece, snap-up-the front cotton/poly nightmares in navy, cobalt, or pale blue depending on which grade.  They required ironing, something we were graded on.   Many of the smaller girls rolled the legs so they looked like bloomers, not a look I could pull off.   

In 9th grade, the gym suits switched over to a navy spandex-like bike short pre-cursor and striped t shirt.  We were required to bring it twice weekly along with a towel for requisite post-class showers, another rite of passage that today's kids don't get.   For so many stay-at-home moms in those days we were far less micromanaged, and expected to remember to bring our required paraphernalia.  No gym suit?  You got a D for the day.  No towel?  Points off for being a grub and not showering.  Left a towel in your locker from last week that is now moldy and smelly?  Definitely points off.  We were checked, towels wrapped about us, to be sure we got wet.  You were allowed one "excuse" per month.  Splash water on your face and shoulders,  get caught not actually showering more than once, and you got detention.  Group showers in high school, shudder.  As if the hygiene and body image issue was not enough of a humiliating rite of passage and source of sleepless nights. 

At the age of 14 I was finally old enough to be a Candy Striper, something I had craved to do since I was 8.  I always knew I wanted to be a nurse, and  I had read and re-read the book "Candy Striper" about 50 times  Being somewhat of a chunky athletic girl, the white short sleeved blouse with the Peter Pan collar and smocked drindl skirt and pinafore just didn't look as I had imagined.  I spent that summer working as a volunteer in the hospital coffee shop, far from the anticipated flower-delivering, water-pitcher-refilling, pillow-fluffing, baby-soothing candy striper I had been expecting. I learned to make tea, toast, oatmeal and coffee, an ominous harbinger of the future.  

High school sports did require uniforms.  Field hockey was actual kilts, and white blouses with numbers on the back. I was terrible at field hockey, and wearing a skirt on freezing November days was not any kind of fun.   I was a JV basketball player for 2 years, but my heart was not in it.  Those uniforms were the same as field hockey, except the kilt was replaced with a plaid culotte thing, I suppose now you'd call it a skort.   For softball we were given t- shirts.  I was a catcher so I wore long pants, I don't think we were even given hats.  Nobody came to our games, anyway.  

Cheerleading was the Holy Grail of high school sports, at least for me, although it was a last minute decision which to try out for, drill team (sort of a dance team) or cheerleading.  My dilemma: drill team had beautiful, short, navy velvet a-line dresses with white fur trim around the collar and hem.  They performed before games and at halftime, wearing white spats over their white keds.   They also did a simple baton routine sometimes, the reason I took lessons for 3 years.  I wasn't great, but I was a definitely better than most on the team.  

I switched gears on that tryout, my best friend was going for cheerleading and I went along and tried out too, shockingly making the team.   In fall, the attire for football cheering was woolen ski sweaters, a white turtleneck, and short wool pleated skirts in school colors with white socks and saddle shoes, yowza!  It was probably the first uniform that actually looked good on my more athletic frame.   It did look better on me than the velvet and fur-trimmed number I suppose.  A plaid kilt, white turtleneck and blue knitted vest with the ubiquitous saddle shoes for basketball cheerleading did not look as good.  I was short, the vest too long.  I resorted to rolling it up and sewing it to prevent bunching.  

I did a brief stint at the drug store soda fountain one or two summers (referred to in an earlier post), which required a really ugly 1950's style waitress-type uniform with a perky little pleated cap thing, which we steadfastly refused to wear. The button-down dress hastily thrown over street clothes was a hideous shade of green that has never existed in nature, ever.  The uniforms were abolished when the soda fountain was demolished to make room for a gift counter.  Man, I missed that grape juice machine.  The uniform sucked, though the new light-blue polyester 3/4 sleeve button-down pocketed smock we were required to wear was only a slight improvement.  

After high school the nurses aide uniform was  a polyester pinstriped, aqua-blue, short sleeved button-down-the-front affair, paired with white stockings, and white Clinic Shoes.  And a very silly cap that matched the uniform.    Nursing school was about the same, only it came in gray and fit much better.  

We were pretty proud of this uniform, as I recall, although they were not the most practical. We earned those suckers.  

Following fashion trends, nursing uniforms went from white dresses, to white polyester pantsuits,  to white scrub dresses with a colorful scrub jacket usually stolen from the OR at my tiny community hospital.  This was followed by a white skirt and colored blouse, and the continuation of white stockings.  At that time it was trendy to also wear white TEDS hose with our dress or skirt, usually stolen from the floors.  Eventually it was just scrubs.  The caps went by the wayside sometime before the 1980's, and  Clinic shoes were mostly worn by older nurses who wouldn't ever have worn anything else.  I loved my white, then black clogs most of my career, as I could never do sneakers.   As for scrubs,  I never hopped on the bandwagon of cartoon character and scrubs-for-every-occasion, it just wasn't me.  I had some prints, but mostly opted for navy, ciel blue, OR green, and of course, black.  During my stint as a school nurse, it was a white or blue scrub jacket over street clothes in which I felt most comfortable.    

Aside from scrubs, there was only one other adult uniform I was required to wear.  I was on an adult figure skating team for years, and we had lots of team attire; jackets, warm up pants, matching skate bags, hats, scarves.  As far as uniforms go, those were the most fun. 

 

...and that's all I have to say about that

 Some months back I posed the question: "Would I recommend nursing as a career?" 

That is a tough one.  My answer isn't an emphatic "yes".

It isn't an emphatic "no", either.   

The job I trained for, and did well, has ceased to exist.  Now that I'm retired, I don't miss the constant struggle of trying to do the job that I knew could, and should, be done.  And feeling not good about it all the time.  

Get a snack.  This is gonna be long.  

My younger self, 19 years old when I started nursing school, would not have survived it today had I not taken the path I did.  For certain I would have flunked out of my first year of training before Christmas.    

I was not an especially good student back then.  I relied heavily on clinical experiences to show me how boring textbook information could magically be transformed into easy-to-understand practical information.  The nursing part came to me much more easily because I  had a head start.  

My dad was a pharmacist who worked for many years at the smallest store of a small chain of old-timey drug stores.  It was seriously tiny.  There was candy, newspapers, and magazines for customers to pick up themselves for purchase, but most of the stuff was behind the counter and people had to ask for it.   There was a soda fountain, and a cosmetics/sundries counter,  that was it.  The pharmacist was in the back out of sight behind cloudy glass.   At 15  I worked as a soda jerk (why was it called that??)  a few hours per week... until it got ripped out and turned into the gift/tobacco counter.  If you wanted anything as scandalous as condoms, you had to ask to speak to the pharmacist, who produced it in a brown paper bag.  The customer was then doubly humiliated by paying the lady behind the counter...if he was a jerk about it.  Sometimes dad delivered the bag and rang the sale himself, coming out from behind the cloudy glass in his white 3/4 sleeve smock giving the kid a break.  When Dad became manager of a much larger store in the chain and eventually general manager of all 7, I became something of a nomad, filling staffing gaps at all the stores where I was needed: cosmetics, gifts, tobacco, pharmacy, surgical supply, and the one store that still had a soda fountain.  All for minimum wage of about $1.65 per hour. 

The summer following my high school graduation I was helping out at one of the stores with "Uncle" John,  dad's first boss, pharmacist mentor, and dear family friend.    I was chatting amiably with an older woman, passing the time while she waited for a prescription.  She asked me what my plans were for the future, as if working in a tiny chain of drug stores wasn't meant to be it.  I told her I was accepted to nursing school for the following year, and planned to try to get a job in a hospital in the fall.  Meanwhile, over her shoulder, I  noticed Uncle John frantically waving, gesturing and pointing to this nice older lady as he stood out of sight behind the prescription counter.  I had no idea what he was on about.  My future was altered thus:

"If you would like to be a nurses aide, we have a six week course starting in two weeks.  I think it is what you are looking for.  Come to my office Monday morning at 10 AM and we can discuss it".  

With that, she left the store.  I was so stunned I failed to ask for details.

Uncle John was practically dancing with glee.  "That was Miss Kennedy!  She is the director of nurses at the hospital"

After I picked my jaw up from the floor I stuttered, "She just offered me a job as a nurses aide.  I'm going in on Monday to talk to her about it".  

I was hired on the spot.  The following week I started a 6 week, 40 hour/week training course.  9 hour days filled with classroom lectures, making occupied beds, giving bed baths to Mrs. Chase, and working in the clinical areas.  Most of this would be repeated in nursing school, but more on that later. 

When I finished  nursing assistant training and was assigned to a permanent unit, the floor nurses treated me differently than the other aides.  Knowing that I had already been accepted to nursing school the following year I became somewhat of a pet project.  I was frequently pulled aside to: 

 "Come see this, come do that, do it this way, not that way".  

"Your nursing instructors next year will be crusty battle-axes bent on failing you".  

"This how you should do it.  Now, stand back while I bounce a quarter off your draw sheet".  

Aside from the usual AM care, PM care, pre-op prep, post-op care, back care, urinal and bedpan cleaning and meal delivering tasks I was sent to in-services meant for RN's, most of which were over my head.  I was taught to do EKG's and D/C IV's, do diabetic foot care and a host of other things.  I learned a lot, plus I am a good mimic, and adopted conversational patterns of those nurses I most admired when interacting with patients.  

In her later, slightly addled years, Miss Kennedy bragged about how she got me into nursing school.  

Many more years later it dawned on me that our encounter was not so serendipitous as it appeared, and suspected Uncle John had probably greased the wheels.  Thus Miss Kennedy and I harbored different delusions of the same the same truth.  The most important fact was that by hiring me for that job, which provided so much experience, she likely kept me from getting kicked out of school the first few weeks.   Perhaps I didn't come across as a clinical nurse-savant, but my instructors immediately knew that I had some experience.  Knowing some clinical skills allowed me to pay more attention to extra-curricular activities study.

My diploma program provided three weekly 8 hour clinical days, which were preceded by an evening of pre-clinical preparation.   Hours and hours spent on chart review, to produce...the dreaded care plan.  How we hated those.  Assessment, Plan, Intervention, Evaluation.  I get why they were necessary, but man, were they tedious.  

Our clinical patients were assigned to us by the mid-afternoon the preceding day, because back then, the instructors knew any patients who were not discharged by noon would definitely be there the following morning.  We lowly students were allowed into the clinical areas after only after 5 PM, neatly attired in dress pants or skirt (no jeans or sneakers), a clean and pressed (emphasis on pressed) lab coat and identification tag (like nobody could tell we were students).  We would eat an early dinner in the hospital cafe, then disperse to the various floors via the medieval tunnel system attaching our  student residence to the hospital by not one, but two underground systems.  We were permitted to introduce ourselves and chat with the patient as long as we didn't get in the way of any of the nurses or house staff.   The first couple of months we had one patient, by New Years of freshman year we had two.   Having had the experience of a full patient assignment on a med-surge floor for a year, one or two patients was a luxury for me.  In those days, aides were given a full 5-6 patient assignment, for which we were expected to provide full care, minus meds and dressing changes unless supervised... as opposed to the current system of the aides being everyone's bitch.  There were only a couple of clinical instructors for all of us, and as we were spread out on different floors, a lot of our supervision  was provided by the floor nurses and upper class students.  Most of them were interested in teaching us, some were not.  A few were quite mean, seeing freshman students as serial killers, thus we learned quickly which ones to avoid.  We muddled through.

As 2nd and 3rd year students we were allowed to work in the hospital as nurses aides, or overnight as patient sitters for demented, usually rich, elderly patients.  Not that we had that much extra time, and I could not manage study, clinical prep, and work more than 1-2 shifts per month, always on a weekend because it was a full 8 hour commitment.  It didn't pay much, but it was still about $.75 more than baby sitting, which I was sick of.  Anyway, we were able to earn a little cash and still get some clinical experience.   As seniors, the floor nurses were much more patient with us, and we were treated as legit extra hands instead of nuisances.  One upperclassman we revered had managed to challenge the LPN  exam prior to her senior year before that loophole was closed forever.  She was able to work as a staff nurse on 3-11 on weekends, and for that was paid about $1.00 more an hour.  She lived on my floor in the dorm, and we assembled at 2:30 to watch with envy as, dressed in a crisp white uniform, she ceremoniously put on her winged white cap at the full length mirror by the elevator.  That cap was very different from those of our school, which were fairly petite, and could be folded so the size and shape of the wings were at our discretion.  The velvet stripes along the edge of  the cap identified us by year:  narrow gray velvet stripes for juniors, and narrow black for seniors, usually handed down from our big sisters.    Upon graduation we wore a 3/4 inch wide black band.  I bought a few yards of black velvet ribbon which I cut into lengths and shared with my friends for graduation.  

My final three months of  clinical experience was team nursing.  We functioned as charge nurses, which included assigning patients to staff, and did treatments, dressings,  and meds.  In those days report was a group activity.  All nurses and supports listened to change of shift report on all patients.  It was apparently mandatory for all staff to smoke cigarettes, and the "lounge" where report occurred was dense with smoke and littered with overflowing ashtrays.  Of course, the patients were also allowed to smoke in their beds as long as there was no oxygen, so perhaps the smoke smell wasn't as obvious.  

As advanced students we could hang IV bottles (yes, bottles) and monitor flow rate, (no pumps in those days) but no IV meds were given on the floor except antibiotics.  An IV team did all the starts, transfusions, and trouble shooting.  They were kind of fanatical about it as I recall, but I learned a lot from watching them.  We were never allowed to learn IV starts in school.  "When you graduate, they will either teach you or have an IV team".   As it happens, I taught myself working nights on a surgical floor, but that is a story for another day.   We gave hundreds of IM injections as medication for pain and nausea were all IM.  I don't recall that too many people were willing to have a shot in the butt every 4 hours for a prolonged period of time, and patients seemed to quickly progress to PO meds.  On the ortho-urology floor we had total hips, a couple of Stryker frames for spinal patients, and lots of 3 way bladder irrigations.  Plus various traction apparatus to play with.   I did this for 3 months.  Because there was an odd number of students in my clinical group, everyone else had to share and got only a few weeks as team leader.  This clinical experience prepared me for my first job out of nursing school as a 3-11 charge nurse on a level 4 rehab floor.  My staff consisted of an LPN, 3 aides and an orderly, all under the age of 29.  I was only 22, one of my aides was 18.  The kids were surely home alone. We were all stupid, but hardly anyone died.   I will leave the story of my first unexpected death for another time, along with details on doing post-mortem care carried out by reading the instructions provided on the pack.  Hilarity ensued.  The 18 year old aide, my roommate at the time, was scared shitless of dead people.  

So, that is kind of a long way around saying that had I not had the clinical experiences I had, I would certainly not have been successful.   It was a good fit for me, I felt like I learned the right way with the right teachers, and was given real-world experience before I graduated.  Mostly med-surg experience year one (lots of chronics), junior year we had pedi, acute med-surg (which included the OR), and OB.  As seniors we had psych, ICU (which included the ER), and Team, although it was actually called Leadership.  Three months in each rotation, two days of lectures, three 7-8 hour clinical days.  

It was a long time ago.  And a far cry from not only the preparation, but the way nurses are allowed to practice nursing.  Learning how to be a nurse wasn't rushed, information wasn't crammed in, and most importantly patients weren't treated like they needed to be shoved out the door.     

Today there is little time to spend with patients who need a bit more encouragement, better teaching, some hand holding.  There just isn't.  What has been systematically robbed from the joy of the job is the human aspect, making someone feel better not just by the things we do for them, but for the things we say, the time we spend, the connection we make.  I saw this first-hand with my husband's heart surgery last year.  Once out of the ICU, it was the aides who did all the care.  He saw the RN twice per shift, and for meds, unless he had a question the aide couldn't answer.  I don't think nurses sign up for this kind of digital, tech heavy, documentation-centered, task-oriented patient care, paying more attention to the computers they must lug behind them.  I know I didn't.  But that is the real world of nursing in the corporate environment.  You can't give the BEST POSSIBLE care to everyone.  If you think that, you are delusional. At the heart of it, there is no monetary value in the very thing that draws people to nursing in the first place. 

Is there any career  that is as idealized as nursing?  Yet, the reality is so far from from the expectation.    I loved being an ER nurse, but bedside nursing has become increasingly unpalatable to new nurses.  Who could blame them?   I got to dislike being abused and treated like an idiot by bullying clipboard commandos and entitled consumers.  Physical violence, verbal abuse on a daily basis.   Never has nursing been less respected; what a sad state of affairs, especially after the last year when nurses were hailed as heroes.  In my opinion, referring to nursing as "a calling" is bullshit, universally utilized by management to undercut nursing, and by nurses to rationalize it.   People need to be right for the job, same as any other career.  For the people in the back, SAME AS ANY OTHER CAREER.  

Alas, as I have said for years, there are no utopias in nursing.  

 Would I have chosen another career?  Maybe.  There are so many more options now, so many more opportunities for learning and individual growth.  It's no wonder that caring, dedicated, educated and experienced nurses are leaving the bedside in droves for better pay, better hours, and better treatment. Or leaving nursing altogether.   Who can blame them?  They SHOULD have little tolerance for the way administrative and clipboard shenanigans interfere with the ability to give excellent patient care.

I think anyone who wants this had better go into it with eyes wide open.  It can be rewarding, and devastating, satisfying and heartwarming.  It can be punishing.   I speak from my 40 plus years as an ER nurse, from my heart which is broken from what nursing has become.  As patients get older, sicker and more complicated, the burden on nurses will continue to increase.  I hope that the next generation of nurses will take a stand, be the agents of change, and demand better.  Someday, and who knows it may be sooner than I like,  I would want such a nurse to take care of me.  

"How do I retire?"

 "So EDNurseasauras, you are 12 months (and a handful of days) into retirement.  How is it going?"

Frankly, it's going great.  

I do miss my co-workers.  I don't miss the stress.  I love not getting up in the morning and dreading that I have to go to work.  Then leaving home an hour before my scheduled shift to find a place to park, and sit in the car for 20-30 minutes listening to spa music trying to psych myself up to go in.   Of course, I didn't recognize I was doing that at the time.   I don't worry about having a specific day/holiday off weeks/months (occasionally a year) in advance.  I've fallen back in love with sewing and have claimed my largely unused upstairs guest room as my own where I can just leave my projects... and the mess.  Yes, I'm teaching myself the fine art of quilting, don't judge me for the cliche.  I've quite a history with sewing entrepreneurship over the years, clothes, alterations, garden flags, curtains, costumes...you name it,  I've probably sewn it.  Except for upholstery.  Beyond cushion covers and pillows,  I draw the line there.   Everything is for fun, or just learning a new skill I haven't tried before.  I am cooking more, my house is mostly tidy and organized.  Some home improvement projects have been completed in lieu of travel.  I am walking again. Without a dog, but walking.  I see my grandson and my children less than I like, but...it's still a pandemic.   

None of my former colleagues around my age are still working in my ER.  In the last months every single one of the Sacrilegious Six in my ER have retired and followed me down (or, out of) the long, dark tunnel into Life After Nursing.

Processing retirement has taken place in a vacuum.  Beyond an occasional chaotic group text most of my former colleagues really haven't had an opportunity speak in depth about what that's like from our perspective.  We're not doing nursing, and not talking about NOT doing nursing.  I don't know if its common among retirees in general, or it is just nurses who have varying degrees of difficulty coming to terms with the end of a career.   I know we all have lots to talk about.

Peg is perhaps the exception.  An ER nurse one year longer than me, one of the many "nurse's nurse" types.   She planned her retirement down to the minute, down to the penny.  She had a countdown calendar on her desk for the last 18 months.  Just before I went out, she was done.  Called out sick her last week, walked out, never came back,  doesn't call or write.  Done.   

Some months ago one of the Sacreligious Six admitted she was  having a tough time.

"Someone needs to teach me how to retire". With several side jobs always, Carla seems to be missing the ER.  She had a small stint working at an addiction center, then at a chain grocery store in the deli.  I get it.   I always said I would retire and work at Chile's, but they closed down 2 years ago in my town.  

"Can I confess?  I retired 7 months ago, and just last week I unclenched my jaw and felt almost like I wasn't going to have to go back".  I get that, I really do.  

I had a few Zoom meetings with my ladies I haven't seen in several years, gals I graduated with from our 3 year diploma program.  We chatted over a few glasses of wine until it just became too tough to stare at a screen (I don't know how people are doing that all day, every day.  Respect to them).  I love these girls like sisters.  We have talked about every aspect of our lives over the years, spouses, deaths of parents, worries about our children, celebration of marriages and grandchildren.  Mostly we talk about what all nurses talk about when they get together.  Nursing.  And now, saying goodbye to that part of our lives.  

Sally updated us on what was going on with her, having been repurposed out of her surgical ICU. "After 6 months working in a Covid ICU,  I noticed I was not on the next schedule.  That's when I knew I was done.  I gave my 2 weeks and walked out.  No party.  No fanfare.  Just done".

Mary gave lots of excuses about why she couldn't be in on the meeting.  Mostly I think she doesn't like Zoom.  I don't see her retiring any time soon, she is a director of nursing where she has worked her entire life, starting in high school as a volunteer.  That's dedication.

Lisa is working remotely on...whatever it is she does,  and plans to retire next summer.  She has grandchildren and is ready to hang it up.  She left clinical many years ago, so I will be interested in her perspective when the time comes.  

Back around Thanksgiving, Cath sent me a text: 

" I just wrote my retirement letter.  It was really hard, I'm kind of crying.  WTF?  And I thought of you...cuz we started all this together"

My nursing school roommate, partner in crime, maid of honor, godmother to my oldest child, we did lots of 'firsts' together.  We took the lamp together, now we pass it on. 

Me: "It is like amputating a part of yourself, it is such a huge part of your identity.  What am I, now that I'm no longer an ER nurse?  It was always a job though, make no mistake.  For me it was more to do with how I did the job and how I was allowed to do it.  There is so little that we can control as nurses, we really can't do the job the way its meant to be done.  Maybe it made it a little easier to accept in the end.  Maybe.  A little.   We can always write a book about how soul-less health care has become". 

Clearly I was still struggling a bit with the reality of retirement.  Resigned but not quite at peace, guilty feelings still, but also relieved, and yes,  I think there is also a bit of Stockholm syndrome there.  Nurses are treated badly.  There, I've said it.   It is other nurses who allow it.  But that is a topic for another day.

I think Cath, who was struggling with her impending retirement didn't recognize that I was loudly saying I'M OKAY!  for my own benefit was well as hers, and she fired back "For some of us nursing was a calling.  It becomes you, and you become it.  I struggle with how I will separate.  Some of my NP colleagues never learned the NURSE part, I feel sorry for them, and their patients".  She is a women's health NP, the most educated woman of all with whom I graduated from my diploma nursing program 44 years ago.  She the one who told me a week before graduation she was not sure she really wanted to be a nurse.  I recognized it for what it was, she was scared shitless.  We all were.  But we were diploma grads, if you didn't get the actual NURSE part, you absolutely could not have made it through. 

"It was more than a job, it was a career and a mission.  I wanted my patients to be able to write their own experiences: births, trauma, whatever needed to be told.  Somedays it feels like a burden to carry all that ability to give a woman an opportunity to write their own history, or their own recovery.  Too melancholy.  Don't let me get a puppy"

I sent her a card with some wise words from someone who had been retired for less than a year.  It had a picture of a puppy.  

We're all okay.  We'll all be okay.  

"

"So, what did I miss?"

 I've been watching "Hamilton".  I have not been in France.  I don't understand why Mr. EdNursesauras and my daughter hated it, I don't like rap but I thought it was brilliant.  

As my friend Cath (who retired last month) says, "I've been remarkably busy doing remarkably little".  But there is routine.  Get up when you want.  Enjoy my morning coffee while I wake up, in no rush to get anywhere most days.  Get out walking.  Spend quiet afternoons enjoying my sewing turret planning and completing projects.  Have a firm lunch date with Mr. EdNurseasauras every week.  The usual drudgery of keeping house, although of that I can say its a piece of cake when you do something every day.  WTF was I thinking all those years when I would spend an entire weekend before a holiday cleaning and putting things in order?  

I've had a lot of time to think about lots of stuff, you would imagine I would have more time to write.  I'm just not sure there is quite enough to write about.  Who wants to see my spice drawer?  Or my sewing projects?  Or the gnome I made out of spruce boughs and red felt for a hat?  I don't think I'm quite there yet, and I'm not sure I'm that kind of a blogger.   I have been reading some books about nurses' training in the last century which is interesting, and I have some thoughts about how that affected my own nursing education, but perhaps Oldfoolrn has that covered.  I dunno, I do enjoy reading about the antics of nurses long ago.

I've realized I have a few regrets about retiring somewhat abruptly.  

Like, not taking a lifetime supply of bandaids.  For the first time in decades, I had to purchase them.  I was not happy with the quality.  I suppose it would have been good to have a bunch of surgical masks early on.  I did have just one that I, like the rest of my colleagues, had to reuse until more became available.  We made do.  We didn't go out much anyway.

I always had a bag full of saline flushes, the result of not emptying the pockets of my scrubs before leaving work.  The syringes, when emptied and dried,  are so handy for storing various things.  I used a few on trips to put a few cc's of moisturizer, shampoo or other liquid to keep to the required 3 ounces rule on flights.   Quite handy.  Now they are all gone.  Sadface.  

I had to use regular scotch tape instead of medical for Christmas gifts this past year.  My family was shocked.

My husband has bi-weekly injections, it would have been nice to pirate a box of alcohol wipes.

A few tongue depressors always come in handy, and my grandson will soon reach the age where he would enjoy simple craft projects.  Ah, well, Popsicle sticks it is.  

I have two pairs of hospital scrub pants to last me the rest of my life.  The really good kind with the thick twill tape, my preferred pajama pants as they are huge, soft and comfy.  My 17 year old scrubs from a previous job have holes in them.  The end of an era.  I have one pair of black work scrubs that I keep in case I need them.  But it is more likely I am just not ready to bury them yet.

On the plus side, I managed to collect about 300 pens.  I won't ever have to buy another one for the rest of my life. 

Just recently I remembered I had a locker at work that I never emptied.  I also never used it.  As I recall, there was several pieces of bubble wrap in there, one of which had the absolutely huge bubbles.  I could never pop it at work because it sounded like gunshots, and I certainly didn't want to be responsible for creating a situation.  I hope the new owner of my locker appreciates my legacy.  

From the home front, swan song part two

I have not worked since mid March.

My last shift was preceded by 10 days of the busiest I can ever remember.   The waits were hours long, it being high season for colds, flu, pneumonia.  I did 5 straight shifts in triage, much of it alone.   One week we had no COVID19 suspects.  Then, a patient with cough, fever, SOB.  The travel to Asia was not mentioned until I specifically asked about it.  Then it started to blow up.  Biogen conference fallout.  COVID suspects were isolated, most not sick enough to need immediate care, so delay in being seen, delay in turning over the room.  Over the weekend, the  COVID condo tent had been erected, staffed by useless people like department heads who never, ever did anything clinical... but they were pretty proud of themselves, high-fiving each other and planning their celebratory drinks after the tent closed at 5 PM.   We got a kick out of watching them congratulate themselves for remembering which end of an electronic thermometer to use, as evidenced by the high living and group congratulations.  They were having their butts handed to them in that tent because the ER was chronically understaffed and we regulars couldn't be spared.   

Then, nothing.  Patient numbers dropped, the tent dwellers dealt specifically with the hundreds of patients who, as usual, were sent to the ER by their PCP.  Most had no symptoms.  The only ER patients were actual ER patients.  No visitors allowed, which was actually....great.  Ghost town.  Not a soul in the waiting room.  

From crazy to eerily quiet.  I worked another couple of shifts.  Then I got sick.   

 BTC (Before the Time of Covid) I would have probably worked my next scheduled shift,  but...with the cough, I was feeling crappy enough (and just a little scared) to go to Urgent care on a Saturday.  I stopped just inside the door and announced myself to the masked nurse in the empty lobby, standing at the ready to intercept and direct the infectious public.  "I have a cough and I'm an ER nurse".

I was given a mask, asked one or two particulars (none of which was "are you short of breath") and sent back to wait in my car.  They would have the PA call my cell phone. 

After 3 or 4 minutes, I was beckoned to a side entrance, shipping door, whatever.   Not through the lobby.  Straight to a room where the PA did the intake, VS, exam, tested for flu and ordered a CXR for pneumonia.  Both negative.  Since I was an ER nurse with symptoms, to my own ER I was directed for Covid testing.  My.  Own.  ER.

I was taken to a negative pressure room.  "I feel stupid", I muttered to my colleague.  From outside the room I read her my VS from my urgent care sheet.  She handed me a portable pulse oximeter since that reading was not documented.  "It's 88", I called out.  "What?!"  "Just kidding, it's 98".

I tested negative for COVID-19.   I waited 4 days for the results.

While I waited, quarantined, I got worse. The cough was relentless.  And the fatigue.  I have rarely had an illness wherein it was necessary to stay in bed and pretty much sleep for three days.  When I wasn't coughing and dizzy, and short of breath from coughing. 

.
I didn't go back to work. I was way too fatigued.  Simple tasks around the house required prolonged rest periods.  This lasted about a month.  Employee health called me every week until the end of April and asked me the same questions about the timeline of my illness.  I'm not sure they ever wrote any of it down.  

Mid-May I wasn't sure I wanted to go back. But I felt guilty.  And worried about money, although  there was no place to go to spend it.  "We're fine.  You don't have to go back to work if you don't want to" , said Mr. Ednurseasauras.  

In early June I was sure I didn't want to.  I still felt guilty.  

By July it was certain.   An impersonal letter from HR removed any doubt.  If I wasn't going to work the minimum required hours as a per-diem, I was done.  I never bothered to respond. 

I was fine with that.  

It took me another month to declare that  I was actually retired from Emergency Nursing after 40-plus years.  

I'm fine with that, too.  

But...would I recommend nursing as a career??

It just isn't funny anymore...a swan song in two parts

I started this blog a long time ago with a post about my husband's experience with his cardiac stent.  A bit over a year ago, he underwent a 4 vessel CABG by way of some mild chest pain and shortness of breath while bicycling.  AFTER we cavorted around Italy.  He has healed quite well, thanks, although not quite up to his own ridiculous standards of physical activity for a man 73-going-on-55.  For anybody else who routinely does not hike mountains and do strenuous bicycling, he is a superstar.  

I have always said as long as I still need the money find humor in the job, I will continue to do it.  The last couple of years have been a tough sell for me, as evidenced by the paucity of amusing posts.

If I thought I was a dinosaur nearly 13 years ago when this blog was born, well....what's older than a dinosaur?

 License on the line every day, every shift.

ER nursing just keeps getting tougher, and I don't mean just the physical aspects, which have certainly taken their toll.  Most of  my coworkers at Satan's Waiting Room for the last 6 years are no longer there.  Many have chucked beside nursing altogether to become nurse practitioners (a lot).  Some retired.  Several excellent nurses have been fired or forced out over some pretty minor shit.  There was an exodus of staff to Gigantic Mega Medical Center, for big bucks, a long commute, traffic, and no free parking.  All in a state tax state, which, to my mind, merely adds a boat-load of headache for even money.   My middle management boss:  a total upper management marionette of stunning uselessness  My upper management boss:  a troll with doctorate.  Neither of them would be safe to give a patient so much as a bed pan.

This pandemic has put the cherry on the turd sundae.

Once upon a time I thrived on learning new things, taking care of really sick patients, knowing how to do all the tasks, run all the machines, anticipate all the meds, trauma, codes, train wrecks of all description.  I loved to be considered a resource for other nurses, a leader, mentor and team player.  I didn't mind the physical aspects so much.  Then.  I've worked for employers good and bad.  Some who valued me for my commitment, or work ethic.  Or comic relief.  A few who saw and cultivated  my leadership potential.

But...the job has changed drastically.  The priority is not the patient.  It is a numbers game, about the money.  Always.   Documentation is directed toward charges, which is not litigation friendly.  Nurses have become chess pieces, more specifically pawns.

As a nurse who has been an advocate of what is best for the patient, I found that I was having to pick my battles.  I had to, you can't fight every minute of every day.  Exhausting.  Providers are gonna do what providers are gonna do.   You can beg, or take a hard line, try to move further up the food chain in time to prevent a really big error.  Others have done that, with predictably poor results for them.  Fortunately, I never had to take things to that level.  

Would I recommend nursing as a career?

To be continued....

It had snowed 2 days before.  Not much, just a couple of inches of fluffy, sugary white stuff.

For days, her little footprints were still clearly visible.  Into the woods behind my house.  Headed half way to my neighbors house to check on his dog.  The flattened area where she rolled.  She loved to roll in snow.

The steady cold weather ensured that those footprints would remain undisturbed for weeks.  Looking at them crushed me and always brought another round of weeping.

When the temperature climbed to  just above freezing, the gradual melt made the prints bigger, then bigger still, until it was  large patches of grass with little snow.   She loved to roll in that, too.  I could somehow still see footprints.

My heart is broken into a million tiny pieces still.  But I can more often think of her without tears.

 I miss her.

  

It was the shoes

The purpose of a triage interview is to gain pertinent information about the patient as quickly and efficiently as possible.   It is best to let the person triaging direct the questions.  It saves a lot time.  It helps when it is actually not painful.

In truth, it is acutely painful at times.

While I was watching the Wizard of Oz recently, it occurred to me that explaining how the triage interview works can be compared to the tale of how Dorothy comes to be present in Oz.  I leave out the Tin Man and the Cowardly lion due to time constraints.


Me: "Why are you here?"

Patient: "Well, there I was, living with Auntie EM and Uncle Henry, and Miss Gulch was mean to Toto**... so I ran away, and.."

Me: "Why are you here TODAY?"

Patient: "Well, because Miss Gulch was taking Toto away, and  I decided to run away from home.  I met this man, a fortune teller, who told me there was a  tornado..."

Me: "What are the SYMPTOMS that caused you to come to the ER today?"

Patient: "After I went up in the the tornado I landed on a wicked witch, then the munchkins told me to follow the Yellow Brick Road...

Me: "Excuse me..."

 Patient:  (keeps talking)... with Toto and the scarecrow, and we were headed to Emerald City because..."

Me: "I'm going to stop you there.  If you could use one word to describe to me the complaint that brings you here today?"

Patient: "Well not really, it's complicated, its about way more than one thing..."

Me: "STOP.  One symptom, impulse or concern.  Just one"

"Oh.  Headache.  But...."

Me:  () Actually, I don't say anything.  The thought bubbles have stolen my speech.

**In my scenario, Toto is an emotional support iguana because Dorothy says he is.  In my opinion he is poorly trained.

ER nurses are really good at IV's.  Patients who profess to have "bad veins, being a really hard stick" and ask for someone "very experienced with difficult veins" are frequently not all that difficult....if you know where to look.    It begs the question, "how do you get good at starting difficult IV's if you don't do it often enough to get good at it?"  Often patients who will pick their IV spot have done so repeatedly, so "that one good vein"  is no longer a viable option.  

Here's what doesn't help:  Snarky and stupid  comments, superior attitudes, and straight up  challenging.  I'll let you decide which is which.  

1.  "Oh, good luck with that"

2.  The last nurse who tried an IV stuck me 15 times (bullshit.  There isn't a nurse on the planet who would do that many sticks.  Most are 3 and done, I'm 2 and done myself).

3.  I can't have any IV's in my hand.  "Why?"  I don't like them there

4.  I'm left handed, suck my thumb, text with that hand, etc, etc, etc.  

5.  It just always hurts if you put it there.

6.  I can only have a butterfly, and a really small one,  

7.   I've never had an IV there before

8.  You get one try.

9.  Trying to explain things to a 10 month old
10. Telling kids "it's not going to hurt".  I never lie.  It will hurt.  I say "pinch", not beesting like many of my cohorts.

I tell the ones who demand the best that I'm better than average with 40 + years of experience.
I tell them I only try an IV if I'm confident.  That is most of the time.
For those who tell me "I usually get blood drawn in this vein", (AKA choosing your IV site) I will always try there first.  Even if I think it's not going to work.  Even if I am dead certain it's not going to work.   You can blame yourself for that, having painted me into a corner.   I have forgotten more places to try IV's than you will ever dream of, even if you are an IV drug user.  And that's saying a lot.

The current trend of using ultrasound for IV's has hit a frenzy in my ER.  There are a few docs who are good at it, really good.  Now we have training available for RN's and paramedics who want to learn, but I will definitely not be one of them.   I have found that with so many people wanting to use the ultrasound and practice this shiny new skill, it has taken the art out of it.  IV starts will go the way of the dinosaur.  As will I, I suppose.  As will I.

Who?

The staff-reduction-cost-saving measure is to have only one nurse in triage when there isn't enough staff for the rest of the department.  Truthfully, we could actually use 2 nurses and a dedicated tech most of the time.  We routinely run at about 114% capacity with a 4 hour wait.

My third shift in a row being alone for 87% of my shift was a steady stream of complaints such as rash, febrile kids, and chest pain.  With a couple of weak and dizzy and a rapid a-fib or two along with frequent flyer depression/suicidals.  We use a language line for the non-English speakers which always takes about 4 times longer to triage.  With a paucity of techs most shifts, or because they have been pulled to sit on suicide watches, I have to do my own EKG's.  The line of patients waiting to be triaged just kept getting longer.  

One patient was a name dropper.  Sigh.  That doesn't do anything to make me change my triage process.

Name dropper pt: "My neighbor is Nurse X, do you know her?  She's the head of all the nurses?"

Nurse X is a clinical leader on one of the med-surg floors.  I know who she is.  Definitely not head of all nurses.

I cocked my head as if considering, gave him a quizzical look.  "Mmmm, nope.  I don't know her".

Name Dropper: (disappointed) "Are you sure, she has a really big, important job".

Me; (knowing whatever I say next will be reported back to the neighbor, and not giving a rat's ass)
"Sorry, no.  People that far up the food chain as you say never come down here.  We frighten them".

Name Dropper had chest pain intermittently for about a week, and after a strenuous workout at the gym resulting in chest pain, consulted the neighbor.

I start the usual protocol, EKG, labs, xray, knowing that there won't be a bed for a few hours.  At least unless the diagnostics indicate a heart attack or whatnot.

I got some pushback for the cardiac protocol, he let me do the EKG, but wasn't sure if the labs and xray were really necessary "because I don't have insurance".

I waste little time, offer that the consequence for not doing so could result in death, and have pretty much moved on to my next impossible list of tasks.  Name Dropper decides to consult with Very Important floor nurse before moving ahead.

Me:  "Ok, well let me know what you decide, you can have a seat in the waiting room while you make your phone call".

Got an email from my manager a couple of days later.  "Nurse X doesn't understand why you told her neighbor that you didn't know her".

Response:  "More importantly, does she know me?"

On practice

I don't routinely do port access.  I once had a bad experience in which a frequent flyer gastroparesis patient, who was also fond of drinking alcohol and was just, in general, a gross individual, sat bolt upright to vomit (spit into a vomit sack) just as I was pushing the needle in.   Scarred me for life.  Seriously, I have port PTSD.

I CAN do it.  I CHOOSE not to.

So when my patient asked me if I was good at ports, I had to tell the truth.  "It's not my best skill", and hit up my zone mate to do it for the second time that day.  I was willing to try it because it looked like an easy one.  She wasn't willing to let me practice.  I was fine with that.

We call it nursing "practice", but when it comes to patients, nobody really wants us to actually PRACTICE on them.

You don't always get the best wherever you go.  You might expect it, but it is a statistical improbability that you will always get it.   Not the best meal, not the best mechanic, not the best teacher.  Not the best hospital. Not the best doctor.  Not the best nurse.  Sometimes you get adequate or mediocre but working on it, or just enthusiastic and learning.   Sometimes you get adequate or mediocre... and just happy to get by.  Even the best role models can't do miracles with the material they have to work with.  The nurse/doctor/lawyer who graduated dead last in the class and passed the boards or the bar is STILL a nurse/doctor/lawyer.

Think about it.

Every nurse on the planet has practiced on patients. Every.  Single.  One.   First patient, first injection, first IV, first code.  First birth.  First death.  First everything.  You don't get better at something unless you do it repeatedly, over and over and over until there is a comfort level.

That said, nobody in health care these days is working in an environment in which actual practice, with the goal of improvement, is encouraged.  Speaking from that place, we all know that perfection is expected from patients and mandated by administration, office dwellers,  and keepers of clipboard minutiae. These folks sequester themselves in their spic and span patient-free ivory towers with the sole purpose of writing how-to's, decision trees, step-by-step procedures, and check- off lists.  All of which serve to create distance from fall-out, (or create a fall guy) when things go off the rails and something untoward occurs. Their work is never done, for there will always be some scenario that was not considered.  Also, shit happens.

Practice does not necessarily make one perfect.  That is impossible.  Practice might make one competent, or safe, or prove that more practice is necessary.  It might even prove that the teacher is not right for the job.  There is lots to learn, but the biggest lesson is that no amount of preparation guarantees perfection.

Nothing is perfect in health care.  That is the only absolute.

House of God

I used to work with a doc who would continuously refer to the Rules of the House of God.  This was a novel, written in the 70's.  You should go read it, if it's still in print, it's doubtful it would be published in this day and age.  For non-jaded health care people, it's dark and full of scurrilous behavior. This doc always used to say that it should be required reading for anyone who works in an ER.

 The House of God outlines a set of rules that are still occasionally referenced by people old enough to remember it. Here they are:

1. Gomers* don't die.
2. Gomers go to ground.
3. At a cardiac arrest, the first procedure is to take your own pulse.
4. The patient is the one with the disease.
5. Placement comes first.
6. There is no body cavity that cannot be reached with a #14 needle and a good strong arm.
7. Age + BUN = lasix dose.
8. They can always hurt you more.
9. The only good admission is a dead admission.
10. If you don't take a temperature, you can't find a fever.
11. Show me a medical student who only triples my work and I will kiss his feet.
12. If the radiology resident and the medical student both see a lesion on the chest x-ray, there can be no lesion
13. The delivery of medical care is to do as much nothing as possible

*an acronym for "Get out of my emergency room" - refers unkindly to old or chronically ill patients who used to sit on a resident's service for weeks awaiting placement in another facilityy in the good old days.  Like, the 1970's.

So I was thoroughly shocked to hear one of my current ER docs,  (probably in his mid 40's, sort of a know-it-all and borderline douche) refer to one my zone mates patients as being unable to go home, and needing a nursing home placement (see rule number 5).

"Yeah", he said airily, "that is one of the rules of The House of God.  Are you familiar with that?, probably not. You're too young.  It should be required reading".

Since he was speaking to my colleague who is in her mid-20's, she did not know.  I interjected.

Me:  "Oh, I used to work for a guy who was a med school classmate of the author, Samuel Shem, in medical school back in the 1970's.   He said it should be required reading too".  I proceeded to rattle off almost all of the rules, having been compelled to memorize them years ago.

The kids promptly started looking for the book, available on Amazon.

Dr. Know-it-all, taken aback, who thinks he is a trivia God: "Wow, you remembered almost all of them".

(Wanders away).

A rehab/nursing home sent a demented patient for a fall.  History of many falls, a hip fracture, and of course, on Coumadin.  He hit his head.  Automatic head CT.

His family member arrived 20 minutes after the ambulance, in a mad tizzy, having been left to cool her heels in the waiting room until he could be triaged and assessed for serious injury.  We almost never (aside from parents of minor children) let ambulance-follower family members into the treatment area right away.  Visitors are strictly limited, and are told by the front desk people that it will be about 10 minutes AT LEAST  before they are escorted back.  We largely get the most pertinent information from the EMT's and paramedics that bring in the patient anyway, and you will shortly see why. 

Me: "So what happened today?"

"I told them to put on his hat because it's very cold out, and dress him warmly!  Look at the shirt he has on, that is not the one I wanted to have him wear!"

The patient was talking a merry blue streak about absolutely nothing.  I inquired as to whether this was the normal level of mentation for him, but the wife kept up with the nonsense about the inappropriate seasonal wardrobe choices that had been made on his behalf.

"He had flannel pajamas on earlier, and a turtleneck, but for some reason they took that off!"

Me:  "Can I confirm his medications and allergies with you?":

"I have no idea if he even had breakfast today!  And those are not the socks I put out for him!"

I resignedly moved on to inquire as to the patient's normal level of activity:

"What if he has to go to the bathroom? I don't know if he has had his bowel movement today!"

I gave up.

She followed me out to my work area, asking about when he would have his scan, when he would get lunch, if her doctor had been notified, if he could have a blanket, urinal, glass of water, TV on channel 8, the heat turned up, the lights turned down, a bag for his belongings, does he need to have an IV.

Here is a small public service announcement.

A rehab is not an acute care facility.  The assistants are taking the vital signs, performing toileting runs, and bringing meals.  They do all of the necessary personal care.  The nurses bring meds and do assessments.  The nurses generally don't see the patients all that much on a shift.  That is a good thing.

And I know this how?

I recently had a family member in rehab.  As a nurse, I am pretty hip as to what is needed in terms of day to day medical stuff.  I have a good handle on the care she received as an inpatient in a acute care facility.  Again: rehab (clap)is not (clap)  an acute (clap) care (clap) facility.  After a couple of minor tussles regarding medication on the first day, (thus likely earning me a reputation as bitchy  pushy) I was quite pleased the care.  The aides are polite, pleasant, and do all the things we as RN's signed up to do but don't have time for anymore, such as making people comfortable.

Beating them up because there weren't exactly 16 blueberries on the oatmeal is just being a douche.

My hat is off to these hard workng ladies and gentlemen for making sure my family member got food she could eat, was kept safe, clean, warm, and comfortable.

....and to all, a good night

Christmas rerun while I wait for my Christmas Eve Chinese food.  

It all started on Christmas night.

It was pretty quiet; we were hanging out in the waiting room watching a very boring movie and chatting when I noticed that the ancient, chipped Nativity set on the small table next to me seemed somehow incomplete.

"Hey", I said to nobody in particular, " did this Nativity come with a Baby Jesus?".

Ellen sat bolt upright. "What?! You gotta be kidding me. I put that out myself! Maybe it fell on the floor?"

We searched around, but it was nowhere to be found. "It's really gone! Who would do that? Who would steal the Baby Jesus? Who would be that low?", said Ellen.

"Well, maybe someone just took it for a joke; you know, like those lawn ornament thingies?", suggested Mary.

"You mean garden gnomes; people would pose them in vacation spots and took pictures? Then they sent the people pictures of their gnomes on vacation?", I said.

"Yes, just like that. Maybe someone took Jesus on vacation", offered Mary.

“Why not?" I said, "to quote my daughter K: 'I like to think of Jesus as wearin’ a Tuxedo T-shirt, ‘cause it says,‘I want to be formal, but I’m here to party too.’"


"That is just terrible. I'm very upset about this", said Ellen in a huff.

I just think it is kind of ironic that someone took the very symbol of one of the most holy days of the Christian calendar from a religious hospital. But that wasn't the end of it, which brings me around to the Christmas decoration sweep over the weekend. Not only was the Baby Jesus MIA, but so was the Mary figurine.

Now Ellen is nearly apoplectic.

"Oh, more crime; what kind of person steals pieces of a Nativity scene. REALLY! People will stop at nothing these days, it is so sad."

“Dear Tiny Jesus, in your golden fleece diapers, with your curled-up, balled-up little fists pawin’ at the air…”

But wait! There's more. During the Christmas cleanup it was discovered that the nativity scene was also missing a farm animal.

Where has Donkey gone? Is he on vacation as well?

Donkey: Oh, man! Where do I begin? First there was the time the farmer traded me for some magic beans. I ain't never gotten over that. Then this fool went off and had a party, and they all starting trying to pin a tail on me. Then they all got drunk, and started hitting me with sticks, yelling "Piñata! Piñata!" What the hell is a piñata, anyway?

This news nearly puts poor Ellen over the edge until Chris from the lab offered an explanation.

"Oh, that. The head broke off, so since I couldn't find the head, I threw the rest of it away".

It is with some effort that I restrain myself from any comments regarding the business end of a donkey. And we have not as yet received any vacation photos, just saying.

Still, I was a little surprised at the lack of quality of the entire sorry set anyway, it should have been long retired. No manger, just a bunch of wise men, a donkey and the holy family sitting on a TV table in the waiting room. Not even in a place of honor.

When I actually put up a nativity set in my house when my kids were small, it went on top of the piano (which I also no longer have). It was the highlight of the Christmas decorating routine, with my kids placing the figures in various positions which were rearranged on a daily basis.

You may recall that my mother was scandalized when the baby Jesus was found to occupy a position on top of the manger when I was a kid, however, that was normal for my family. Often, the scene was embellished with one of the many dozens of Fisher-Price doll people, as well as Match Box cars, Transformers, plastic toy soldiers, boats, china animals, and a fence from one of the 50-pack plastic farm animal sets, many of which also joined the fun. The 3 wise men were plenty crowded; it was quite a party in there. My mother just shook her head.

My daughter drew the line at the plastic He-Man and other Masters of the Universe that my son J would add. "That's not 'propriate", she would say.

"He's guarding Jesus", J would explain.

Usually, though, at the end of the day Jesus was on the roof, but He-Man was at his post protecting him, and all was right with the world.

Next year I'm gonna bring in that He-Man in case Jesus returns. Just sayin'.

Well, ok...

That last post was so I could add one more than last year.

But I just wanted to add to my post of a couple of days ago in which my family member experienced the joys of the season in the ER.  She has been admitted to the hospital and doing pretty well.  The family looks to me to be critical, but she has been receiving excellent care.

On the way in to the hospital a couple of days later to visit I encountered a locked door.  I'm not all that familiar with the hospital anymore.  It has been over 40 years since I knew my way around, and it has changed drastically.

Along with the locked door, I encountered a confused older woman with a cane who inquired as to where the main entrance might be.

(I assume I must have some kind of light radiating from me that indicates I am a health care professional and stand at the ready to render assistance).

"I think it's up the hill there", I pointed.  "I came in this door the other day".

"Well, it took me a long time to get here, I'm not going to be able to get up that hill", she looked mildly distressed, glancing around and waiting for someone to save her.

Sigh.  "I'm going to try this door right down this ramp.  I'll come down with you, then check to see it there door is open".

We walked down the incline, and I deposited her on a bench, huffing.  As I clearly saw people walking out the door, I called back to inquire if she wanted me to get her a wheelchair.

"Yes, if you can get someone to push it".

Sigh.  That would be me.

I settled her into the wheelchair and we entered the building.  There was no reception area, only a bank of elevators.   I asked her which floor she would be visiting on.

She looked blank.  "I don't know".

Sigh.  Sigh.  I espied a telephone on a table nearby, and pushed her next to it.  "OK, pick up that phone, dial "o", and ask, the operator will direct you".

Brief conversation ensued.  "X Building, 9th floor", she said with satisfaction, clearly in no rush to find someone other than myself to take her there.  Good thing I was headed to the same building, except I was only going to the 7th.  But first she had to drop the stack of papers she was carrying.  She wasn't going to pick it up.  I couldn't leave it.

So,  I took her in the wheelchair up the elevator  to the 9th.  "I am ok from here", she said as I neared a wheelchair stall around the corner from the nurses station.  "Thank you, and I'll be sure to pay it forward"

"I'm sure someone will be very grateful, have a nice day".

Later, as I was headed to my car in the parking lot, another older, confused appearing woman stopped me.  "Do you know where the main entrance is?"

Sigh.  Sigh.  Sigh.

Hey! Look what I got!